JOB STRAIN AND THE PREVALENCE AND OUTCOME OF CORONARY-ARTERY DISEASE

Background It has been hypothesized that jobs that have both high psyc hological demands and low decision latitude (''job strain'') can lead to coronary disease. The objective of this study was to test whether j ob strain was correlated with the presence of coronary disease at angi ography or with long-term outcome in patients with angiographic corona ry disease. Methods and Results Employed patients under the age of 65 years undergoing diagnostic coronary angiography completed a self-admi nistered questionnaire about their job duties and work environment. Jo b strain was measured by the method of Karasek. Patients were separate d into three groups, based on extent of coronary disease: significant disease (greater than or equal to 75% stenosis), insignificant disease (>0% but <75% stenosis), and normal coronary arteries. Statistical an alyses were performed using logistic regression and the Cox proportion al hazards model. The 1489 patients enrolled had a median age of 52 ye ars; 76% were male and 88% were white. By design, all patients were em ployed, 60% in white-collar jobs and only 16% in jobs requiring heavy labor. Traditional cardiac risk factors were most prevalent in the 922 patients with significant coronary artery disease, at intermediate le vels in the 204 patients with insignificant disease, and least prevale nt in the 363 patients with normal coronary arteries (all P<.01). Job strain was actually more common in patients with normal coronary arter ies (35%) than in patients with insignificant (26%) or significant dis ease (25%, P<.002). In a multivariate analysis, job strain was not sig nificantly correlated with the presence of coronary disease. Job strai n was not correlated with angina frequency at the time of angiography. Job strain was not a predictor of cardiac events (cardiac death or no nfatal myocardial infarction) during follow-up. Conclusions Job strain was not correlated with the prevalence or severity of coronary artery disease in a cohort of patients undergoing coronary angiography. The outcome of patients with angiographically defined coronary disease was not affected by the level of job strain as measured by the method of Karasek.